- Also Known As:
- Acute pancreatitis
- Chronic pancreatitis
- Alcoholic pancreatitis
- Pancreatic inflammation
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Signs and Symptoms
- Severe upper abdominal pain that may radiate to the back and often increases after eating or lying flat. (The pain is sometimes referred to as “epigastric” because it occurs in the upper middle part of the abdomen.)
- Nausea, vomiting
- Rapid pulse
- Abdominal swelling and tenderness
Sometimes, however, acute pancreatitis attacks are severe and complications can develop, such as:
- Tissue death (necrosis)
- Pancreatic pseudocysts (sacs filled with fluid and dead tissue that can become infected)
- Low blood pressure, which can lead to shock
- Difficulty breathing
- Kidney failure
It is important that you see a healthcare practitioner because symptom severity does not necessarily reflect the amount of damage that may be occurring and because other conditions that require different treatments may cause similar symptoms.
Diagnosing and treating severe attacks as soon as possible are critical to prevent complications and to reduce inflammation and limit infection. Repeated bouts of acute pancreatitis can lead to chronic pancreatitis.
People with chronic pancreatitis may have recurring attacks with symptoms similar to those of acute pancreatitis. These attacks often increase in frequency as the condition progresses. Pain with chronic pancreatitis may be severe and continuous or intermittent. It may be made worse with eating or drinking, especially drinking alcohol.
Over time, as more of the pancreas becomes scarred, the cells that produce digestive enzymes are destroyed. This can cause:
- Pancreatic insufficiency
- Unintended weight loss
- Buildup of fluid in the abdomen (ascites)
- Pancreatic pseudocysts—sacs of fluid and destroyed tissue that can become infected
- Greasy, foul-smelling, fatty stools
As the cells that produce insulin are destroyed, you may develop diabetes.
Pancreatitis is diagnosed with a physical exam and medical history, blood tests, and imaging tests. At least two of the three following criteria must be present to diagnose acute pancreatitis:
- Abdominal pain that is “consistent with the disease”
- Levels of lipase or amylase (enzymes made by the pancreas) that are three times higher than the upper limit of normal
- “Characteristic” abdominal imaging results
Blood tests are used to measure the levels of two enzymes made by the pancreas:
- Lipase (the preferred test)—this is an enzyme that helps digest fats. The lipase test is more specific than amylase for diseases of the pancreas, particularly for acute pancreatitis and for acute alcoholic pancreatitis. Levels start to rise within 4 to 8 hours of the onset of pancreatitis symptoms and typically return to normal within a week. Acute pancreatitis is diagnosed if the lipase level reaches 3 times above the upper limit of normal. As chronic pancreatitis gets worse, lipase levels may be normal or decreased.
- Amylase—this is an enzyme that helps digest carbohydrates. While the amylase test is sensitive for pancreatic diseases, it is not specific. That means an elevated amylase level may indicate a problem, but the cause may not be related to the pancreas. Levels start to rise 2 to 12 hours after the onset of acute pancreatitis symptoms and typically return to normal within a week. Acute pancreatitis is likely if the level reaches 3 times above the upper limit of normal. Amylase also may be monitored in people with chronic pancreatitis. It will often be moderately elevated until the cells that make it become damaged, at which point blood levels of amylase may be decreased.
Other blood tests may be used to help diagnose or detect complications of acute pancreatitis. These tests may include:
- Complete blood count (including white blood cell count to diagnose infection)
- Comprehensive metabolic panel (including bilirubin, liver enzymes)
- C-reactive protein (a measure of inflammation)
Other laboratory tests that may be used to help diagnose and evaluate chronic pancreatitis include:
- Stool elastase—this test measures the level of elastase (an enzyme made by the pancreas) in a sample of your stool. The amount of this enzyme is reduced if you have pancreatic insufficiency, which can be caused by chronic pancreatitis.
- Chymotrypsin—this test measures chymotrypsin (a pancreatic enzyme that breaks down proteins) in your stool. Chymotrypsin is absent in the stool if you have pancreatic insufficiency.
- Immunoreactive trypsinogen (IRT)—this is a blood test that measures trypsinogen, an inactive precursor produced by the pancreas that is converted to the enzyme trypsin. Trypsin is the pancreatic enzyme that digests proteins. IRT may be elevated with pancreatitis.
- Sweat (chloride) test for diagnosis of cystic fibrosis
- Tests for genetic mutations such as those associated with cystic fibrosis (CF Gene Mutation Testing) or other causes of hereditary pancreatitis
- Fecal fat (fat in the stool)—this test detects excess fat in your stool, often the first sign of pancreatic insufficiency. Because the stool elastase test (see above) is easier to perform, it has largely replaced this test.
Imaging tests that might be used to help diagnose pancreatitis include:
- Computed tomography (CT) scan: can be used to detect inflammation or scarring of the pancreas
- Endoscopic retrograde cholangiopancreatography (ERCP): an endoscope (a hollow tube) is guided through your mouth, down your throat and stomach to your small intestine. A smaller tube (catheter) is inserted through the endoscope to inject contrast dye into the pancreatic and bile ducts. Abdominal x-rays are taken to examine the pancreas, gallbladder, and the ducts that carry digestive enzymes from those organs to the small intestine. ERCP can be used look for blockages or damage to the ducts.
- Magnetic resonance cholangiopancreatography (MRCP): a specific type of magnetic resonance imaging (MRI) that uses powerful magnets and radio waves to create images of the pancreas, pancreatic duct, and bile ducts. It is often used before or instead of ERCP to look for abnormalities in the pancreas because it is faster and non-invasive. It is also useful in distinguishing pancreatitis from pancreatic cancer.
- Ultrasound: may be used to create and send images of your pancreas to a video monitor. An endoscopic ultra sound is an exam that involves a thin, flexible tube that is used to view inside the digestive tract and is more accurate than an abdominal ultrasound.
For more information on imaging studies, visit RadiologyInfo.org.
Prevention and Treatment
- Stop drinking alcohol
- Don’t smoke
- Maintain a healthy body weight
- Eat a low-fat diet
Pancreatitis demands prompt medical attention. During an acute attack, there is the potential for the pancreas to be destroyed within a matter of hours and complications can be life-threatening.
Treatment usually takes place in a hospital and may consist of:
- Pain medications
- Antibiotics to treat an infection
- Fasting (not eating or drinking) to let your pancreas “rest” for several days until symptoms go away
- Fluids given intravenously (by IV)
- Nutrition given through a tube inserted through your nose into your digestive tract (nasogastric or NG tube)
Your healthcare team will monitor for and treat any complications. Surgery may be needed to treat the underlying cause of your pancreatitis, such as gallstones. If you overuse alcohol, treatment for alcohol dependence may be recommended.
Chronic pancreatitis is treated by trying to prevent future attacks, minimizing pancreatic damage, and by addressing damage already done. You may be given enzymes taken as pills to help with digestion. You also may need to supplement your diet with fat-soluble vitamins and calcium. Glucose (blood sugar) is often monitored, and insulin injections may be given if you have developed diabetes. Oral diabetes medications (e.g., sulfonylureas) do not usually work in these cases.
Pain control is an important part of treatment as there may be ongoing moderate to severe pain, so you may be given pain medications. As the disease progresses and more pancreatic tissue is destroyed, the pancreas may not work properly or stop working and the pain level may drop.
Surgery may be necessary in some cases to remove all or part of the pancreas and/or to remove or bypass obstructions. For more on this, see the links in Related Content below.
People with chronic pancreatitis are at a higher risk for developing pancreatic cancer. As your healthcare practitioner monitors your chronic pancreatitis, the practitioner also will be watching for cancer.
What is pancreatitis?
Pancreatitis is inflammation of the pancreas. It can occur short-term (acute) or can be long-lasting (chronic).
The pancreas is a narrow, flat gland about six inches long located deep in your abdominal cavity, behind the stomach and below the liver. It has head, middle, and tail sections. Its head section connects to the first part of the small intestine (duodenum).
- Inside the pancreas, small ducts (tubes) feed digestive enzymes and bicarbonate produced by the pancreas into the pancreatic duct. This large duct carries the digestive enzymes and bicarbonate down the length of the pancreas, from the tail to the head section, and into the duodenum.
- The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine.
- The bile duct and pancreatic duct usually join just before entering the duodenum and share a common opening into the small intestine.
The pancreas consists of two kinds of tissues that perform different functions:
- The exocrine pancreas makes, stores and releases powerful enzymes to digest fats, proteins, and carbohydrates in the small intestine. The enzymes normally are produced and carried in an inactive form to the small intestine, where the enzymes are activated as needed. Exocrine tissues also make and release bicarbonate that neutralizes stomach acids and allows for the activation of pancreatic enzymes.
- The endocrine pancreas produces hormones, including insulin and glucagon, and releases them into the blood. These hormones regulate sugar (glucose) transport into the body’s cells, where it is used for energy and to help maintain normal blood sugar levels.
Pancreatitis can occur when digestive enzymes become activated while still inside your pancreas, causing irritation and injury to pancreatic tissue and leading to inflammation.
In acute pancreatitis, inflammation develops quickly and then goes away after a few days to weeks.
- The main causes are gallstones that block the pancreatic duct and long-term alcohol abuse.
- Moderate to severe attacks may require a long hospital stay to monitor for and treat serious complications.
- With treatment, mild attacks may get better after a few days. In mild cases, your pancreas may return to normal once it has healed.
- Recurrent attacks of acute pancreatitis can lead to chronic pancreatitis.
Chronic pancreatitis is long-lasting inflammation in the pancreas.
- Long-term alcohol abuse is the main cause. If you smoke cigarettes, you are also at increased risk for the condition.
- It can lead to the formation of scar tissue in the pancreas that keeps it from working properly.
- A pancreas that does not work properly can lead to digestive problems and diabetes.
Pancreatitis occurs more often in men than in women. It is becoming more common in the U.S., though the reasons for this aren’t clear. About 275,000 people are hospitalized with acute pancreatitis each year. Chronic pancreatitis is less common, with about 86,000 people hospitalized.
Gallstones and long-term alcohol abuse are the main causes of pancreatitis. Other causes include:
- Use of medications such as valproic acid and estrogen
- Viral infections such as mumps and Epstein-Barr virus
- A very high blood triglyceride level or a high blood calcium level
- Cystic fibrosis (or being a carrier of a gene that causes cystic fibrosis [see CF Gene Mutations Testing])
- Inherited defects that result in early activation of digestive enzymes
- Pancreatic cancer
- Certain autoimmune conditions
- Injury (trauma) to the pancreas
Some cases of acute and chronic pancreatitis have no clear cause.
Pancreatitis can cluster in some families, and there are several known genes that contribute to increased risk for pancreatitis.
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Gregory C. Sephel PhD FACB MT(ASCP). Lab Tests Online adjunct board member. Director Clinical Pathology, VA TN Valley Healthcare System; Associate Professor Pathology, Microbiology, Immunology, Vanderbilt University School of Medicine.